Health plans get mixed reviews in annual California report card

Two thirds of medical groups were rated three or four stars, which translates… (Myung J. Chun / Los Angeles…)

California’s annual report card on many of the state’s HMOs and other health insurance plans gave most of those rated high marks for customer satisfaction but said they need to improve treatment for lung disease, attention-deficit disorder and throat infections in children.

The state said more than a third of consumers expressed problems with how the companies resolved complaints.

The report, released Wednesday from the state Office of the Patient Advocate, rated California’s nine largest health maintenance organizations, six largest preferred provider organizations and 212 medical groups representing 16 million consumers with private health plans.

These comparisons of health plans and physician practices are increasingly valuable for patients as they face higher out-of-pocket medical costs and the federal healthcare overhaul expands coverage to millions of more consumers. The report card can be found at http://www.opa.ca.gov/.

“This type of public reporting is keeping people accountable,” said Sandra Perez, director of the patient advocate office, which helps the state assess healthcare quality and makes recommendations to the Department of Managed Health Care.

“When you have this data online and accessible, it encourages providers to pursue quality improvements. It brings about changes in the policies of many health plans,” Perez said.

This latest edition of the report card noted that health plans improved on several patient-quality measures, such as exceeding national averages for diabetes care and doing better at controlling high blood pressure and cholesterol.

But the state said HMOs and PPOs scored lower this year in providing heart attack medication. There was also room for improvement by health plans in giving flu shots to adults and providing treatment for alcohol and drug abuse.

Patrick Johnston, president and chief executive of the California Assn. of Health Plans, said companies will continue to work with medical providers and regulators on improving patient care.

Kaiser Permanente was the only HMO in the report card to earn the top four-star rating for meeting national standards of care, which measures adherence to recommended medical practices.

Among PPOs, Aetna, Cigna and UnitedHealthcare led the way with three-star ratings on the same measure.

Perez said consumers express frustration about getting cost estimates for medical procedures and learning how much their health plan will cover as well as getting claims paid correctly.

She said a woman recently called her office to complain about getting an unexpected $500 bill related to childbirth and a 60-something consumer faced a surprising $200 co-pay for a colonoscopy at her doctor’s office.

Fourteen of the 15 health plans rated received one or two stars on a four-star scale for customer service, including questions about costs and claims.

Western Health Advantage was the lone exception, receiving a three-star rating for plan service. Overall, 33% of HMO members and 43% of PPO members said they were dissatisfied with complaint resolution, according to the state.

The report card singled out Aetna, Blue Shield of California, Health Net and Kaiser Southern California for posting improvement on member scores for getting patient care easily and plan service.

Medical groups fared better overall on patient experience. Two thirds of medical groups were rated three or four stars, which translates as good or excellent.

Californians can use the report card to research medical groups by name or county. These government scores and other insurance company ratings are used more and more to gauge physician performance and determine their financial bonuses and penalties.

“Regardless of how the economy is doing, we need to get value for our healthcare dollars,” Perez said. “Getting a better value is essential for your personal health and our nation’s health.”